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Exploring the Long-Term Disability Outcomes in Trauma Patients: Study Protocol. RESEARCH SQUARE 2024:rs.3.rs-4238506. [PMID: 38659840 PMCID: PMC11042389 DOI: 10.21203/rs.3.rs-4238506/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Objectives Post-discharge patient-reported outcomes from trauma registries can be used to measure trauma care quality. However, studies reflecting the Asian experience are limited. Therefore, we aim to develop a digital trauma registry to prospectively capture patient-reported outcomes (PROs) at one-, three-, six-, and twelve-months post-injury in Pakistan. Methods We will use a cohort study design to develop a digital trauma registry at two tertiary care facilities (Aga Khan University Hospital & Jinnah Postgraduate Medical Center) in Karachi, Pakistan. The registry will include all admitted adult trauma patients (≥18 years). Data collection will be digital using tablets, with mortality, level of disability, and functional status, quality of life being the outcomes. Telephonic interviews will be conducted with the patients and caregivers for follow-up data collection. Discussion The high disability burden following accidental trauma imposes a significant burden and cost on individuals and society. Therefore, the trauma registry would fill this gap by capturing post-discharge long-term PROs. It will provide the injured patient's post-discharge situation, challenges, and future directions for incorporating long-term PROs in low-resource settings. Including long-term measures in routine follow-ups will provide insights into physical, social, and policy barriers and help advance injury care research.
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Exploring the experience and burden of injury and acute care in Pakistan. Injury 2023; 54 Suppl 4:110903. [PMID: 37573066 DOI: 10.1016/j.injury.2023.110903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
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Understanding maternal choices and experiences of care by skilled providers: Voices of mothers who delivered at home in selected communities of Lusaka city, Zambia. Front Glob Womens Health 2023; 3:916826. [PMID: 36683603 PMCID: PMC9852978 DOI: 10.3389/fgwh.2022.916826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Background Significant proportions of women living in urban areas including the capital cities continue to deliver at home. We aimed to understand why mothers in a selected densely populated community of Lusaka city in Zambia deliver from home without assistance from a skilled provider during childbirth. Methods Using a phenomenological case study design, we conducted Focus Group Discussions and In-depth Interviews with mothers who delivered at home without assistance from a skilled provider. The study was conducted between November 2020 and January 2021 among 19 participants. Data were analysed using content analysis. Results Individual-related factors including the belief that childbirth is a natural and easy process that did not require assistance, lack of transport to get to the health facility, influence and preference for care from older women who were perceived to have the experience and better care, failure to afford baby supplies, and waiting for partner to provide the supplies that were required at the health facility influenced mothers' choices to seek care from skilled providers. Health system-related factors included mistreatment and disrespectful care such as verbal and physical abuse by skilled healthcare providers, stigma and discrimination, institutional fines, and guidelines such as need to attend antenatal care with a spouse and need to provide health facility demanded supplies. Conclusion Individual and health system access related factors largely drive the choice to involve skilled providers during childbirth. The socioeconomic position particularly contributes to limited decision-making autonomy of mothers, thus, creating challenges to accessing care in health facilities. The health system-related factors found in this study such as mistreatment and disrespectful care suggests the need for redesigning effective and sustainable urban resource-limited context maternal health strategies that are culturally acceptable, non-discriminatory, and locally responsive and inclusive. Rethinking these strategies this way has the potential to strengthening equitable responsive health systems that could accelerate attainment of sustainable developmental goal (SDG) 3 targets.
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Teaching systems science to public health professionals. Public Health 2020; 181:119-121. [PMID: 32007781 DOI: 10.1016/j.puhe.2019.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Systems thinking aims to understand the overall behavior of a system by examining the interdependencies of parts of the system. The objective of this study is to increase awareness of systems thinking and systems modeling in public health research and practice. STUDY DESIGN A short course was offered to public health professionals using a combination of teaching modalities: didactic lectures, group discussions, hands-on programming, and experiential learning. METHODS Course participants completed surveys and provided feedback on the effectiveness of the course. A description of participant backgrounds, survey responses, and feedback were summarized. RESULTS Overall, participants offered quantitative and qualitative feedback suggesting that course content was useful and effective for incorporating systems thinking/modeling in their public health practice. CONCLUSIONS Systems thinking can be taught through formal modes of instruction to public health workers, but more research and case studies are needed to identify who should be taught and when and how such instruction should take place given competing priorities of public health workers.
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Changes in brain-behavior relationships following a 3-month pilot cognitive intervention program for adults with traumatic brain injury. Heliyon 2017; 3:e00373. [PMID: 28795168 PMCID: PMC5545767 DOI: 10.1016/j.heliyon.2017.e00373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 06/22/2017] [Accepted: 07/27/2017] [Indexed: 01/21/2023] Open
Abstract
Facilitating functional recovery following brain injury is a key goal of neurorehabilitation. Direct, objective measures of changes in the brain are critical to understanding how and when meaningful changes occur, however, assessing neuroplasticity using brain based results remains a significant challenge. Little is known about the underlying changes in functional brain networks that correlate with cognitive outcomes in traumatic brain injury (TBI). The purpose of this pilot study was to assess the feasibility of an intensive three month cognitive intervention program in individuals with chronic TBI and to evaluate the effects of this intervention on brain-behavioral relationships. We used tools from graph theory to evaluate changes in global and local brain network features prior to and following cognitive intervention. Network metrics were calculated from resting state electroencephalographic (EEG) recordings from 10 adult participants with mild to severe brain injury and 11 age and gender matched healthy controls. Local graph metrics showed hyper-connectivity in the right inferior frontal gyrus and hypo-connectivity in the left inferior frontal gyrus in the TBI group at baseline in comparison with the control group. Following the intervention, there was a statistically significant increase in the composite cognitive score in the TBI participants and a statistically significant decrease in functional connectivity in the right inferior frontal gyrus. In addition, there was evidence of changes in the brain-behavior relationships following intervention. The results from this pilot study provide preliminary evidence for functional network reorganization that parallels cognitive improvements after cognitive rehabilitation in individuals with chronic TBI.
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A case study of researchers’ knowledge and opinions about the ethical review process for research in Botswana. RESEARCH ETHICS 2016. [DOI: 10.1177/1747016116677250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most countries, including Botswana, have established Institutional Review Boards (IRBs) to provide oversight of research involving human beings. Although much has been published on the structure and function of IRBs around the world, there is less literature that empirically describes the perspectives of stakeholders in low- and middle-income country (LMIC) settings regarding IRB processes. In this study, we employed primarily quantitative methods to examine the perceptions of researchers at the University of Botswana (UB) about the review of research protocols by local IRBs. Data were collected using a web-based survey (SurveyMonkey1). This was a preliminary effort to document some of the emerging experiences of researchers with ethics review in a context where both research and research oversight are relatively new. Findings from 85 researchers indicate that researchers recognized the need for an IRB to review all human research protocols, expressed the need for research ethics training, experienced high rates of approval at government ministries and UB, and generally believed that ethics review processes can help researchers themselves better understand and appreciate research ethics in general. Though only about one-quarter of respondents reported a more positive view of research ethics after interacting with the UB IRB, 56.5 percent reported no change. In contexts where IRBs have recently been established, it can be particularly important to document the perspectives of researchers in order to align expectations with capabilities, and identify areas where IRBs can improve operations. Future efforts to advance research ethics and ethical review in Botswana should include establishing research ethics training requirements and courses for researchers, increasing investment in IRBs and their training, further developing institutional and national research ethics policies, and formalizing agreements between IRBs and others involved in research oversight in the country to support coordinated review.
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916 A five-year time trend analysis of road traffic injuries [RTIS] and deaths among infants and toddlers in Qatar. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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992 Time trends in work-related injuries in qatar: an analysis of hospital trauma registry data. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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509 Child restraint system use in Mexico. What does the law say? Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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770 An evaluation of the utility of various data sources for occupational injury surveillance. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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740 Factors associated with child restraint system use in three cities of Mexico. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Quantifying the burden of injuries in temporary labour migrants: an analysis from the United Arab Emirates. THE LANCET GLOBAL HEALTH 2015. [DOI: 10.1016/s2214-109x(15)70151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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The neglected burden of caregiving in low- and middle-income countries. Disabil Health J 2014; 7:262-72. [DOI: 10.1016/j.dhjo.2014.01.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 12/27/2013] [Accepted: 01/20/2014] [Indexed: 11/28/2022]
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First standardised field sobriety test in Brazil. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590o.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Caretaker perceptions of childhood home safety and injury risks in Karachi, Pakistan: a qualitative study. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590a.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Increasing seat belt use in the Russian context: tailored social marketing campaign and concerted strengthened enforcement. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590w.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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DEVELOPING, IMPLEMENTING, AND EVALUATING TRAUMA CARE SYSTEMS: EXPERIENCES FROM LOW- AND MIDDLE-INCOME COUNTRIES. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580e.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The validity of self-reported seatbelt use in a country where levels of use are low. ACCIDENT; ANALYSIS AND PREVENTION 2012; 47:75-77. [PMID: 22326412 DOI: 10.1016/j.aap.2012.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/28/2011] [Accepted: 01/11/2012] [Indexed: 05/31/2023]
Abstract
The validity of self-reported seatbelt use among low belt use populations in low belt use countries has not been evaluated directly. Nine hundred and ninety drivers were recruited from shopping centers, car parks, and other suitable locations located in Afyon and Ankara cities of Turkey in order to compare the self-reported and observed seatbelt usage rates. Data sets were collected simultaneously from the participants not being aware of having their seatbelt use observed. Participants interviewed in Afyon (n=301) and Ankara (n=658) reported seatbelt usage ("always using a seatbelt") rates of 39% and 45%, respectively. When observed, however, only 47% in Afyon and 70% in Ankara of these drivers actually fasten their seat-belts. It seems that the drivers in both cities exaggerated their use seat belts considerably.
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SP6-23 Unintentional childhood home injuries: a case study from Karachi, Pakistan. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976p.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Improving cell yield and differentiation potential of PCMOs: Effect of cell source and growth conditions in culture. J Stem Cells Regen Med 2010; 6:71. [PMID: 24693090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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The political culture of road traffic crash control. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Childhood unintentional injuries surveillance in Ismailia governorate, Egypt. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Why mothers choose to enrol their children in malaria clinical studies and the involvement of relatives in decision making: evidence from Malawi. Malawi Med J 2008; 20:50-6. [PMID: 19537433 PMCID: PMC2748955 DOI: 10.4314/mmj.v20i2.10957] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was aimed at researching the reasons why mothers enrol their children in malaria clinical research and how family members or relatives are involved in the decision-making process. Issues related to informed consent were also a particular focus of this study. A total of 81 participants took part in 8 focus group discussions. Thirty-nine participants were recruited from Blantyre, an urban setting, and forty-two participants were from Chikwawa, a rural setting. All the participants were mothers whose children had participated or were participating in the Intermittent Prevention Therapy post-discharge (IPTpd) Malaria Research. A majority of the participants reported that they chose to participate in the IPTpd research as a way of accessing better quality medical care. They also decided to enrol their children in order to benefit from the material and monetary incentives that were being given to participants for their participation. Most participants reported that they made the enrollment decisions on their own. They informed their family members/marital partners about their enrollment decisions after they had given their consent. A few made their enrollment decisions after consulting their family members. There was also a sense of trust in health workers who asked the potential participants to join the IPTpd research. Most participants decide to take part in malaria research because of better medical treatment. Partners and relatives play a very small role in the decision-making process of participants in malaria clinical research. Research participants'have a sense of trust in health workers who enrol them in clinical research.
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Gamma-aminobutyric acid up- and downregulates insulin secretion from beta cells in concert with changes in glucose concentration. Diabetologia 2006; 49:697-705. [PMID: 16447058 DOI: 10.1007/s00125-005-0123-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 11/01/2005] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS The role of gamma-aminobutyric acid (GABA) and A-type GABA receptors (GABA(A)Rs) in modulating islet endocrine function has been actively investigated since the identification of GABA and GABA(A)Rs in the pancreatic islets. However, the reported effects of GABA(A)R activation on insulin secretion from islet beta cells have been controversial. METHODS This study examined the hypothesis that the effect of GABA on beta cell insulin secretion is dependent on glucose concentration. RESULTS Perforated patch-clamp recordings in INS-1 cells demonstrated that GABA, at concentrations ranging from 1 to 1,000 micromol/l, induced a transmembrane current (I(GABA)) which was sensitive to the GABA(A)R antagonist bicuculline. The current-voltage relationship revealed that I(GABA) reversed at -42+/-2.2 mV, independently of glucose concentration. Nevertheless, the glucose concentration critically controlled the membrane potential (V (M)), i.e., at low glucose (0 or 2.8 mmol/l) the endogenous V (M) of INS-1 cells was below the I(GABA) reversal potential and at high glucose (16.7 or 28 mmol/l), the endogenous V (M) of INS-1 cells was above the I(GABA) reversal potential. Therefore, GABA dose-dependently induced membrane depolarisation at a low glucose concentration, but hyperpolarisation at a high glucose concentration. Consistent with electrophysiological findings, insulin secretion assays demonstrated that at 2.8 mmol/l glucose, GABA increased insulin secretion in a dose-dependent fashion (p<0.05, n=7). This enhancement was blocked by bicuculline (p<0.05, n=4). In contrast, in the presence of 28 mmol/l glucose, GABA suppressed the secretion of insulin (p<0.05, n=5). CONCLUSIONS/INTERPRETATION These findings indicate that activation of GABA(A)Rs in beta cells regulates insulin secretion in concert with changes in glucose levels.
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Perception of Users and Providers Regarding District Level Emergency Care System in Pakistan. Ann Emerg Med 2005. [DOI: 10.1016/j.annemergmed.2005.06.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Effect of extracellular pH on insulin secretion and glucose metabolism in neonatal and adult rat pancreatic islets. Acta Diabetol 2001; 38:171-8. [PMID: 11855795 DOI: 10.1007/s592-001-8075-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Changes in extracellular pH are known to affect glucose-stimulated insulin secretion. In the present study, glucose metabolism in pancreatic islets cultured at different pHs was investigated. Also, for islet transplantation purposes, insulin secretion and glucose metabolism were compared in neonatal and adult islets at different pHs to determine which islet preparation is more tolerant to acidity and alkalinity. The results revealed a dependency of insulin secretion on the external pH in both neonatal and adult islets. Reduction of insulin secretion was observed at both the acidic and alkaline sides of pH 7.3. Glucose stimulated increases of insulin secretion in all cases. Similar results were obtained for ATP and pyruvate contents. Intracellular insulin increased with the increase of pH value. In contrast, calcium content decreased with the increase of pH. The results demonstrate that neonatal islets are more acid tolerant than adult islets. Both basal and glucose-stimulated insulin secretions, as well as other parameters of neonatal islets were significantly higher than those of adult islets in response to low pH. The differences under alkaline conditions were not significant but give an indication that neonatal islets are more tolerant to alkalinity than are adult islets.
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Oxygen profile of microencapsulated islets: effect of immobilised hemoglobin in the alginate matrix. Transplant Proc 2001; 33:3511-6. [PMID: 11750499 DOI: 10.1016/s0041-1345(01)02418-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Purity of alginate affects the viability and fibrotic overgrowth of encapsulated porcine islet xenografts. Transplant Proc 2001; 33:3517-9. [PMID: 11750500 DOI: 10.1016/s0041-1345(01)02419-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bull World Health Organ 2000; 78:1207-21. [PMID: 11100616 PMCID: PMC2560622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Recent estimates suggest that malnutrition (measured as poor anthropometric status) is associated with about 50% of all deaths among children. Although the association between malnutrition and all-cause mortality is well documented, the malnutrition-related risk of death associated with specific diseases is less well described. We reviewed published literature to examine the evidence for a relation between malnutrition and child mortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% of deaths in children worldwide. METHODS MEDLINE was searched for suitable review articles and original reports of community-based and hospital-based studies. Findings from cohort studies and case-control studies were reviewed and summarized. RESULTS The strongest and most consistent relation between malnutrition and an increased risk of death was observed for diarrhoea and acute respiratory infection. The evidence, although limited, also suggests a potentially increased risk for death from malaria. A less consistent association was observed between nutritional status and death from measles. Although some hospital-based studies and case-control studies reported an increased risk of mortality from measles, few community-based studies reported any association. DISCUSSION The risk of malnutrition-related mortality seems to vary for different diseases. These findings have important implications for the evaluation of nutritional intervention programmes and child survival programmes being implemented in settings with different disease profiles.
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Differences in mortality after fracture of hip: the east Anglian audit. BMJ (CLINICAL RESEARCH ED.) 1995; 310:904-8. [PMID: 7719180 PMCID: PMC2549290 DOI: 10.1136/bmj.310.6984.904] [Citation(s) in RCA: 230] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate differences between hospitals in clinical management of patients admitted with fractured hip and to relate these to mortality at 90 days. DESIGN A prospective audit of process and outcome of care based on interviews with patients, abstraction from records with standard proforma, and follow up at three months. Data were analysed with chi 2 test and forward stepwise regression modelling of mortality. SETTING All eight hospitals in East Anglia with trauma orthopaedic departments. PATIENTS 580 consecutive patients admitted for fracture of neck of femur. MAIN OUTCOME MEASURE Mortality at 90 days. RESULTS Patients admitted to each hospital were similar with respect to age, sex, pre-existing illnesses, and activities of daily living before fracture. In all, 560 (97%) were treated surgically, by a range of grades of surgeon. Two hundred and sixty one patients (45%; range between hospitals 10-91%) received pharmaceutical thromboembolic prophylaxis, 502 (93%; 81-99%) perioperative antibiotic prophylaxis. The incidence of fatal pulmonary emboli differed between patients who received and those who did not receive prophylaxis against deep vein thrombosis (P = 0.001). Mortality at 90 days was 18%, differing significantly between hospitals (5-24%). One hospital had significantly better survival than the others (odds ratio 0.14; 95% confidence interval 0.04-0.48; P = 0.0016). CONCLUSIONS No single factor or aspect of practice accounted for this protective effect. Lower mortality may be associated with the cumulative effects of several aspects of the organisation of treatment and the management of fracture of the hip, including thromboembolic pharmaceutical prophylaxis, antibiotic prophylaxis, and early mobilisation.
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Abstract
Tensions generated in selected bands of the four major ligaments of the flexed knee (40-90 degrees) have been measured in vitro when the tibia is subjected to passive anterior translation and axial rotation with and without a compressive preload. The measurements were made in 30 fresh-frozen specimens using the buckle transducer attached to the anteromedial band of the anterior cruciate ligament [ACL (am)], the posterior fibres of the posterior cruciate ligament [PCL (pf)], the superficial fibres of the medial collateral ligament [MCL (sf)], and in the total lateral collateral ligament (LCL). Particular attention was placed on the evaluation of the performance of the transducer specific to such measurements in order to minimize the errors associated with the use of this transducer. The results indicate that, among the measured ligaments, substantial tension (greater than 20 N) is generated only in the ACL (am) in tibial anterior translation up to 5 mm. The tension pattern generated in response to tibial axial rotation, however, is complex and exhibits considerable variation between specimens. In general, both the MCL (sf) and LCL are tensed at all tested flexion angles, with the tension in external rotation being significantly greater than in internal rotation. At 40 degrees of flexion, the ACL (am) bears tension mainly in internal rotation, while at 90 degrees of flexion the PCL (pf) is tensed in both senses of rotation. The response of the LCL shows marked variation among specimens; very small tension (less than 15 N) is generated in internal rotation in 48% of the specimens, and in either sense of rotation in 20% of the specimens. The tension in the ACL (am) in internal rotation is invariably greater in those specimens in which LCL tension is negligible. This correlation between increased ACL (am) function and inadequate LCL restraint appears significant in terms of ACL injury and repair.
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Abstract
The aim of this study is an experimental evaluation of a force analysis of the patellar mechanism based on the assumption that patellofemoral contact is frictionless. At first, the geometric characteristics of contact surfaces, a prior knowledge of which is necessary for quantitative analysis, were measured from radiographs of 42 fresh-frozen knee specimens in the flexion range 0-120 degrees. The results were then used in the analysis to predict the relations between the forces acting on the patella. For the evaluation of the analysis, the ratio of the tension in the ligamentum patellae and the rectus femoris was measured in ten specimens during simulation of two knee functions: (1) "leg raising" against a resistance; and (2) "static lifting". The effect of flexion angle on the ratio is found to be rather complex. With increasing flexion, the ratio increases initially up to 30 degrees, then decreases up to 90 degrees, and finally increases again beyond 90 degrees. The ratio is above unity up to around 45 degrees and below that in the remaining flexion range. The analysis has been found to predict not only the characteristic variation of the ratio but also its magnitude with reasonable accuracy. It has been concluded that for an accurate prediction of the patellofemoral joint reaction, the force analysis needs to be based on the geometry of the contact surfaces. This implies that the mechanical consequences of surgical procedures involving tibial tubercle relocation cannot be inferred simply on the basis of their effect on the patellar mechanism angle, but that they also require consideration of their effect on the contact geometry.
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